An interesting case of intrathyroidal parathyroid adenoma.

To cite: Sadacharan D, Mahadevan S, Ravikumar K, et al. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/bcr-2015210351 DESCRIPTION Intrathyroidal parathyroid adenomas are an uncommon cause of primary hyperparathyroidism (PHPT) and their prevalence varies from 1.4% to 6%. 2 We present a case of a 42-year-old woman with residual PHPT, operated elsewhere, with localisation of parathyroid tumour on ultrasonography and sestamibi scintigraphy on the right side of the thyroid gland (figure 1). Review of the operative records revealed a search for the parathyroid tumour on the right side, along the eutopic sites of the superior and inferior parathyroids up to the innominate vein. Frozen section and histopathology revealed only normal parathyroids and the patient remained hypercalcaemic postoperatively. A few months later sestamibi scintigraphy was again performed with no change in the findings. Re-exploration did not reveal a tumour in the previously operated sites and hence the thyroid was carefully palpated and a nodule was felt in the right lobe of the thyroid. A hemithyroidectomy was performed and the cut section showed a parathyroid adenoma (1.7×0.9 cm) encircled by a rim of thyroid tissue confirming its intrathyroidal location (figure 2). Histopathology confirmed the same. Postoperatively the patient remained eucalcaemic.